Healthcare Provider Details

I. General information

NPI: 1578642849
Provider Name (Legal Business Name): JUDITH LENIHAN RN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 EUSTIS PKWY
WATERVILLE ME
04901-5173
US

IV. Provider business mailing address

79 RIVER RD
DETROIT ME
04929-3213
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-2136
  • Fax: 207-872-4522
Mailing address:
  • Phone: 207-873-2136
  • Fax: 207-872-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR036078
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: